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Open Access Research article

Use of the ‘patient journey’ model in the internet-based pre-fitting counseling of a person with hearing disability: lessons from a failed clinical trial

Vinaya Manchaiah12*, Jerker Rönnberg2, Gerhard Andersson23 and Thomas Lunner24

Author Affiliations

1 Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK

2 Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden

3 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden

4 Eriksholm Research Centre, Oticon A/S, 20 Rørtangvej, Snekkersten, Denmark

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BMC Ear, Nose and Throat Disorders 2014, 14:3  doi:10.1186/1472-6815-14-3

Published: 7 April 2014



Persons with a hearing impairment have various experiences during their ‘journey’ through hearing loss. In our previous studies we have developed ‘patient journey’ models of person with hearing impairment and their communication partners (CPs). The study was aimed to evaluate the effectiveness of using the patient journey model in the internet-based pre-fitting counseling of a person with hearing disability ( Protocol Registration System: NCT01611129, registered 2012 May 14).


The study employed a randomized controlled trial (RCT) with waiting list control (WLC) design. Even though we had intended to recruit 158 participants, we only managed to recruit 80 participants who were assigned to one of two groups: (1) Intervention group; and (2) WLC. Participants from both groups completed a 30 day internet-based counseling program (group 2 waited for a month before intervention) based on the ‘patient journey’ model. Various outcome measures which focus on self-reported hearing disability, self-reported depression and anxiety, readiness to change and self-reported hearing disability acceptance were administered pre- and post-intervention.


The trial results suggest that the intervention was not feasible. Treatment compliancy was one of the main problems with a high number of dropouts. Only 18 participants completed both pre- and post-intervention outcome measures. Their results were included in the analysis. Results suggest no statistically significant differences among groups over time in all four measures.


Due to the limited sample size, no concrete conclusions can be drawn about the hypotheses from the current study. Furthermore, possible reasons for failure of this trial and directions for future research are discussed.

Hearing disability; Patient journey; Pre-fitting counseling; Failed clinical trial; Dropouts; Treatment compliancy